Local treatment in unresectable hepatic metastases of carcinoid tumors: Experiences with hepatic artery embolization and
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Local treatment in unresectable hepatic metastases of carcinoid tumors: Experiences with hepatic artery embolization and radiofrequency ablation Vincent Meij1, Johanna M Zuetenhorst2, Richard van Hillegersberg1, Robert Kröger3, Warner Prevoo3, Frits van Coevorden1 and Babs G Taal*2 Address: 1Department of Surgery, Netherlands Cancer Institute/ Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands, 2Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands and 3Department of Radiology, Netherlands Cancer Institute/ Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands Email: Vincent Meij - [email protected]; Johanna M Zuetenhorst - [email protected]; Richard van Hillegersberg - [email protected]; Robert Kröger - [email protected]; Warner Prevoo - [email protected]; Frits van Coevorden - [email protected]; Babs G Taal* - [email protected] * Corresponding author
Published: 17 November 2005 World Journal of Surgical Oncology 2005, 3:75
doi:10.1186/1477-7819-3-75
Received: 01 July 2005 Accepted: 17 November 2005
This article is available from: http://www.wjso.com/content/3/1/75 © 2005 Meij et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Hepatic metastases of carcinoid tumors cause incapacitating symptoms, but are usually diffuse and therefore unresectable. In this article we evaluate our experiences with local treatment techniques in the management of carcinoid patients with hepatic metastases and failing systemic treatment. Methods: Fifteen consecutive carcinoid patients (11 men and 4 women; median age 60 years; range 45–71 years) were treated with either hepatic artery embolization (HAE) with Ivalon particles or radiofrequency ablation (RFA) (percutaneously or intra-operatively). Follow-up evaluation was performed by CT scan and 24-hours urinary 5-HIAA excretions. Results: A total of 18 HAE's was performed in 13 patients, while 10 lesions in 3 patients were treated with RFA. Median follow-up was 12.5 months (2 – 25 months). Median duration of symptoms was 22 months (8 – 193 months). Median overall decrease of 5-HIAA excretion 2 months after HAE was 32% with tumor regression on CT-scan in 4 patients (30%) and improvement of symptoms with a median duration of 15 months in 3 of them (23%). Embolization led to fatal hepatic failure in one patient. The 3 patients treated with RFA showed a decrease of urinary 5-HIAA values of 34, 81 and 93% respectively, with tumor regression in all of them. Improvement of symptoms was reported in 2 patients up to 25 months. Conclusion: Liver embolization performed late in the clinical course had limited effect on symptoms and biochemical and radiological parameters. First experiences with RFA are favorable and mig
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